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HCTP Annual Interdisciplinary Workshop - Thoughts from Day 2 March 23, 2004

Posted by Hans in : conferences & conventions, research , add a comment

Before I get into some of my thoughts on the issues and ideas presented during the second and final day of the workshop, I had a few additional thoughts based on yesterday’s posting.

The first thought, and perhaps most interesting to me, is about ehealth (my apologies for using the term “ehealth” as if it were an object). Can we describe ehealth as a “convergence” of disciplines, or is it better described as a launching point for newly “emergent” types of research. In the first metaphor, I would liken ehealth to a central train station or marketplace where people of different interests and backgrounds come together in a central spot. I suppose in one extreme example, the human body could be another example - we have disparate systems that more or less work independently, but have inter-dependent, inter-related, and symbiotic relationships with the rest of the “system”. The second example of a divergence point would be something akin to a prism breaking up white light into the rainbow. “White” light seemingly becomes a spectrum of colours. I know that this second metaphor isn’t a very good one - perhaps something like a petri dish would be better. Regardless, I think it’s interesting to think about ehealth and what the ramifications are - are we converging, diverging, or doing both (i.e., converging only to ultimately diverge)?

My second thought relates to the idea of using hospitals as metaphors for other industries or institutions. I awoke this morning and realized that the Christian religion, through the teachings of Jesus, use medical metaphors (and by logical extension, hospitals) to describe its members and institutions. I suppose in some sense, a hospital metaphor could be used to describe a church. I never really made this metaphorical connection (at least consciously), but I am finding the modern hospital’s organizational structure to be very interesting - something that I think modern churches could (and should) study. I find that the separation between the management/administrative and medical/clinical functions are separated. I argue that these two functions should remain separated as the skills required to do either successfully are not necessarily compatible - besides, it isn’t logical to assume that highly proficient and successful physicians would necessarily be good managers. In this way, I argue that churches (and religions in general) should begin to nurture and recruit professional managers to operate the managerial and administrative functions of institutions, much like hospitals are beginning to do.

Okay, enough about metaphors and onto today’s presentations.

Morning Session: Technologies & translations: Sustaining interdisciplinarity

The Artist-in-residence program, National Research Council & Canada Council for the Arts (Andrew Woodsworth)Prototyping the future in the information age (Brian Cantwell-Smith)

Andrew Woodsworth shared about the “artist in residence program”, which is a program to have artist work collaboratively with other scientists to help in non-traditional ways. Some work by one of the artists was presented. I found the work that was presented to be absolutely stimulating. I can’t really articulate it, but I think the effect was felt. Basically, the thrust of the program is to help examine new ways of approaching problems and to try and be creative about conceptualizing issues.

Brian Cantwell-Smith shared a well-thought out, brilliantly articulated presentation on inter/cross/multi/trans-disciplinary research. I now call inter/trans/multi/cross-disciplinary research as “-”research. Actually, he presented a great number of different ideas. Should -disciplinary research move toward “disciplinizing”? How are intrinsically -disciplinary problems addressed? He made an assertion that methods of inquiry are now moving “beyond disciplinarity”. What I found absolutely delightful was how he described -disciplinary research: multi-culturalism in the intellectual realm.

Both of the these presentations had considerable resonance with me, as to me, I felt as if my lived experiences of being trained as a multi-disciplinary researcher were validated in some way. I would perhaps go even further to suggest that the challenges that are being faced by those in this research space must address issues of “self-identity” - who are we as researchers? There were concerns from students and junior faculty members wondering how to promote oneself or how to find “home” departments.

Breakout Session 1: Epistemological considerations: Publications about HCTP interdisciplinary research

We were supposed to discuss publication issues, but it turned out to be a continuation of the morning session. What I found was that my particular experiences haven’t been shared by others. In fact, my overwhelmingly positive experiences with -disciplinary training and research makes me even more appreciative of all the mentors and teachers that I have ever had. There was some peripheral discussion about the possibility of creating a new journal for HCTP.

Afternoon Session: Technologies@work: Knowledge & complexity in health care

Health care technology for humans (Kim Vicente)

Kim Vicente shared some of his work and thinking on human factors issues in technology design. I found the presentation to be very stimulating, particularly in his conceptualization of systems (i.e., an organization) as a “technology” that needs to be designed and understood a multiple levels.

Breakout Session 2: Health technologies @ work - brainstorming new HCTP research

We really didn’t brainstorm much in this session. Perhaps it was because it was the final session and that people were a bit mentally drained from the stimulation over the past two days.

Closing thoughts

Overall, I had a wonderful time. Not sure if I “learned” very much in terms of knowledge uptake, but it was very refreshing to be in a closed environment with like-minded people interested in “-disciplinary” research. I met several new people with very interesting research topics examining a plethora of topics. Hopefully I’ll be able to nurture these encounters into something more productive. In any case, it was very encouraging. I’ll probably write some more in the days to come as I’m able to process all of the things that I experienced.

Okay - time to focus on my thesis…

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HCTP Annual Interdisciplinary Workshop 2004 - Day 1 thoughts… March 22, 2004

Posted by Hans in : conferences & conventions, research , 2comments

It’s been a while since I last posted, but I’ve been somewhat caught up on readings and preparing some of the background work for my thesis/dissertation work. In any case, I attended this year’s Health Care, Technology, & Place (HCTP) Annual Interdisciplinary Workshop held at St. Andrew’s Club in Toronto, Canada. Here are some of my thoughts from day one.

Morning Session: How does “place” matter?

1. Ubiquitous health technologies: The research opportunities to 2010 (Guang Zhong Yang)

2. Between everywhere and nowhere: The inescapable emplacement of technology (Pascale Lehoux)

Professor Yang from Imperial College, UK presented current work being undertaken to develop technologies to enable “ubiquitous technologies” for health related purposes. Some of the research is somewhat astounding to me, as the technology to create embedded and implanted monitoring systems that are smaller than a penny currently exists. I was even more surprised at some of the predictions of things to come by the year 2010. Prof. Yang was talking about having a “sensor net” that can remotely monitor any physiological measure using either micro-optics or any other type of implantable technology. The fascinating thing was that this “sensor net” that one (for lack of a better term) wears on the body would be connected to a larger IT infrastructure that allows for remote monitoring for adverse events, and ultimately, pre-event interventions based on risk-factors, genetic pre-disposition, and a host of other issues. Of course, I’m greatly simplifying and summarizing the talk, but to me, it felt as if science fiction was becoming reality.

The second presentation was by Professor Pascale Lehoux, who presented her work assessing remote dialysis programs in Quebed. Specifically, she presented her research comparing a “satellite” hospital type of system that used traditional telemedicine type technologies vs. a traveling bus type model. The questions that were raised centered around the issue of place affecting interactions, technologies, and the substantive experiences of patients and health care workers.

I have a list of different questions and thoughts on the presentations, but one question that I wonder about revolves around the notion of protected and/or restricted place/space. Just because we can monitor or provide services remotely and perhaps even ubiquitously, in ways that are so unobtrusive to the host, does it mean we should? How is choice and preference to be addressed? Are there times/places/areas in which we, as a society, decide not to monitor? I mean, the question of continuous surveillance, even for benevolent reasons, raises some interesting questions.

Some additional random thoughts:

- with increased monitoring, are we moving to “medicalize” normal conditions?

- are we moving toward determinate medicine (what about genetics?)?

- does technology need to be specifically designed for health care?

Breakout session 1: 21st Century Hospitals

We had an interesting discussion around inter/multi-disciplinary research about the 21st century hospital. The most important thing that resulted in this discussion was around the metaphors we use to describe hospitals. For example, many of the “modern” hospitals have been designed and operated (even if subconsciously) as if they were “hotels” or “shopping malls” (or even perhaps department stores). But, Pascale Lehoux wondered if a better metaphor for envisioning a hospital could be a “prison”. One of the PhD students (I’m sorry, but I can’t remember her name) shared an absolutely fascinating metaphor: hospital as “theatre” in which there is the actors and the play as well as the front and back of the stage.

For me, I found the notion of metaphors to be challenging. As ehealth challenges and transforms the health care institutions and systems, the metaphors we use to describe hospitals will ultimately shape the redesign. I wonder why health care continues to borrow metaphors and ideas from other industries to try and describe the relationships within, rather than accepting that health settings (and hospitals) are unique. Why can’t other industries try and use health care metaphors to describe their institutions - a hospital is a hospital is a hospital. Does “technocentricity” lead to behaviour changes and ultimately (improved) outcomes? In what contexts and places can/does this occur?

Afternoon session: Technologies in/on/of the body: Health, self, personhood

1. The body electric online: e-addiction, Penelope complex, e-lag and other e-pathologies (Derrick De Kerckhove)

2. The politics of life in the 21st century (Nikolas Rose)

This afternoon session was started by Prof. De Kerckhove talking about some of the addictive/neurotic behaviours that are beginning to emerge as we become increasingly “connected”. One assertion is that we are beginning to mimic biological systems by recreating them as external (i.e., wireless, pervasive, and always on), digital nervous systems - interesting, huh? He spoke about so many different ideas that I can’t do it justice. However, I will share the one point that struck me: what is health in the digital era? Here’s an interesting word that I heard from the presentation: technobiology.

The second presentation was by Prof. Nikolas Rose and he spoke about “emergent life” citing examples of genetics, miniturization, and a host of other factors. I can’t recall the specifics of the presentation, but he make some very interesting assertions about humanity, the role of technology, future emergent life forms, and notions of citizenry. One of the audience members asked about some of the ramifications on society of becoming inter-connected via digital means, and for whom will this type of scenario apply. I found it interesting that these notions of emergent life, community, and society would only be for those of the privileged, “advanced democratic liberal nations” (I’m not sure what that means, but I think it’s only for those who can afford it).

Breakout session 2: Translating your research for uptake (knowledge translation & transfer)

This session was facilitated by Gale Murray of the Change Foundation, describing the new strategic alliance between the Change Foundation and HCTP. We discussed a number of topics regarding knowledge translation and transfer, and tried to come up with some practical tips on how to do this (with some real life examples). One of the things that I cannot escape thinking about is this assumption that knowledge must be transferred/translated.

Some random thoughts from this discussion:

- we need to consider who the “audience” for research is

- what is the intended outcome of research? Of knowledge transfer/translation?

- how can messages be communicated effectively to the general public?

Closing thoughts

Day 1 was interesting. I had a chance to meet some very bright people from diverse backgrounds. I’m actually interested to see what Day 2 brings. The one thing that I am continuously thinking about is how the ideas presented relate back to my research in ehealth, or what new insight could be found by applying these models/ideas to ehealth?

I’m currently reading the “The Cathedral and the Bazaar” by Eric Raymond. The book is considered to be an absolute must-read for those interested in open source software. I’m reading it to learn more about open source software, and to see what I can learn and apply to ehealth research. It’s an interesting read so far - hopefully I’ll be done by the end of the week. Expect a summary/review once it’s done, as I’m sure I’ll have some thoughts on it. I’ve been discussing open source development with MJ Suhonos, and we’ve been having some really interesting conversations. I hope that after reading the book, I will be able to have a more intelligent conversation with him.

Popularity: 16% [?]

eHealth in the news March 9, 2004

Posted by Hans in : conferences & conventions, news, research , add a comment

Here are some news that I stumbled onto regarding eHealth during the past week or so:

European e-Government to get €37.5M from EU eTEN programme

Funding announcement for public-private projects on Europe’s “e” projects, including eHealth.

DO-IT-YOURSELF diagnosis is a popular online activity

An article in the Friday March 5, 2004 edition of the Toronto Star. Alex Jadad was interviewed for this article.

Conferences

  • E-health 2004: Challenges today for success tomorrow: The annual COACH conference to be held in Vancouver BC from May 8-11, 2004.
  • MedInfo2004: Building high performance health care organizations: This year, the annual AMIA conference and the MedInfo conference are being jointly held in San Francisco from September 7 - 11, 2004. I’m told that the AMIA/MedInfo conferences are the conferences to attend for those interested in the academic side of medical/health informatics and eHealth. The HIMMS conferences are geared more toward vendors and products. I would love to attend this conference - hopefully I’ll be able to find funding to help me out.

    Health Affairs article

    Health Affairs just published an article titled “Physicians’ use of electronic medical records: Barriers and solutions” trying to make a link between use of EMRs and improved quality of care.

    • Popularity: 14% [?]

    Reading list March 8, 2004

    Posted by Hans in : resources , add a comment

    As part of my PhD preparations, I’ve been spending large portions of my reading, and still finding that there is too much material to cover. I’m in the midst of compiling a reading list for ehealth. The plan is to post this growing list in the research section of my site once I get a chance to work on it. Here is a list of my initial suggestions (apologies in advance for incomplete references):

    There are more, but this is just a start. Any additional suggestions?

    Popularity: 13% [?]

    Qualitative resources March 8, 2004

    Posted by Hans in : research , add a comment

    Here are some interesting on-line resources regarding qualitative research:

    - an interesting paper by Myers titled “Investigating information systems with ethnographic research”

    - Action Research Resources - an online site dedicated to action research/qualitative methods

    I’ve found several more, but I’m currently in the process of reviewing the materials, so I will update this post once I’ve gone through the information.

    Popularity: 9% [?]

    Open Source March 7, 2004

    Posted by Hans in : open source , add a comment

    I’ve been thinking about open source software (OSS) and its potential. Actually, I’m interested in investigating the relationship, if any, between OSS and ehealth. I understand the following things about OSS:

    What really boggles me is in trying to understand the “business model” for open source software companies. This notion of “making freely available” one’s intellectual property (IP) is somewhat perplexing to me. In the traditional product (and even service) models of business, IP is a closely guarded secret - something that you don’t share. Money is made when you allow people to use the IP, but not have it.

    I’ve been having on-going discussions and debates with fellow members of the Centre (Grant McInnes and MJ Suhonos) about developments and possible applications to ehealth. I think that OSS can be used very effectively within health care - just not sure how. More to come on this topic as I think it through.

    If you are interested in learning more about OSS, you can try the following two resources:

    1. The Cathedral and Bazaar: I’m told that this book is lthe “bible” for open source, outlining the history, development, and current issues. The link takes you to Amazon.com’s page for the book.

    2. Open Source Conference by the Knowledge Media Design Institute: This conference is being held at the University of Toronto (May 9 - 11, 2004). There is a session on open source and health care which should be interesting.

    Popularity: 13% [?]